CMS Formulary

Displaying 109301-109310 of 1611142 results.
ID: 109301
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 2001565
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 109302
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 2001566
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 109303
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 2001568
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 109304
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 993781
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 109305
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1049221
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 109306
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1049225
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 109307
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1049214
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 109308
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1091497
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 109309
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1091392
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 109310
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1091145
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30